Staff Absence Form

Employee Name

Email

example@example.com

Todays Date

Date

School/Building

Day(s) Requested

Type of Funeral Day(s)

Do Not Proceed Without Proper Supervisor APPROVAL

Reason for Personal Day (Reason must be given if used before or after holiday or if consecutive personal days are used).

Reason for School Business Day (Proper documentation must be submitted with this form)

Is Reimbursement Required?

I hereby request reimbursement for expenses incurred while attending (List Title of Convention, Conference, Workshop: Title of Event*

To be Held on:

Date

At (Name of venue and address):

My estimated expenses are:

Rows	Amount
Registration Fee (if any)
Transportation
Car Allowance (Mile @ $0.47 per contract)
Tolls
Accommodations
Other Expenses (Parking, Etc)
Total

Date 1

Date

Date 2

Date

Date 3

Date

Employee Signature

Notes

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